Maternal near-miss at university hospitals with cesarean overuse: an incident case-control study
2016 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 7, 777-786 p.Article in journal (Refereed) Published
INTRODUCTION: Cesarean section (CS) carries a substantial risk of maternal near-miss (MNM) morbidity. This study aimed at determining the frequency, causes, risk factors, and perinatal outcomes of MNM at three university hospitals with a high rate of CS in Tehran, Iran.
MATERIAL AND METHODS: An incident case-control study was conducted from March 2012 to May 2014. The modified WHO near-miss criteria were used to identify cases. A control sample of 1024 women delivering at the study hospitals was recruited to represent the source population. Near-miss ratio, crude and adjusted odds ratios (aORs) with confidence intervals (CI) were assessed.
RESULTS: Among 12 965 live births, 82 mothers developed near-miss morbidities and 12 died. The MNM ratio was 6.3/1000 live births. Severe postpartum hemorrhage (35%, 29/82), severe pre-eclampsia (32%, 26/82), and placenta previa/abnormally invasive placenta (10%, 8/82) were the most frequent causes of MNM. Women with antepartum CS (aOR 7.4, 95%CI 3.7-15.1) and co-morbidity (aOR 2.3, 95%CI 1.4-3.8), uninsured Iranians (aOR 3.4, 95%CI 1.7-7.1) and uninsured Afghans (aOR 4.7, 95%CI 2.4-9.2) had increased risks of near-miss morbidity. Stillbirth and extremely preterm birth were the most prominent adverse perinatal outcomes associated with MNM.
CONCLUSION: Overutilization of CS clearly influenced the causes of MNM. A lack of health insurance had a measurable impact on near-miss morbidity. Tailored interventions for reducing unnecessary CS and unrestricted insurance cover for emergency obstetric care can potentially improve maternal and perinatal outcomes. This article is protected by copyright. All rights reserved.
Place, publisher, year, edition, pages
2016. Vol. 95, no 7, 777-786 p.
Maternal near-miss; cesarean section; placenta previa; abnormally invasive placenta; Afghan migrant; health insurance; Iran
Obstetrics, Gynecology and Reproductive Medicine
IdentifiersURN: urn:nbn:se:uu:diva-296830DOI: 10.1111/aogs.12881ISI: 000380358900008PubMedID: 26918866OAI: oai:DiVA.org:uu-296830DiVA: diva2:939962